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S. HRG. 111–832 

REAUTHORIZING THE OLDER AMERICANS ACT: 

ENCOURAGING HEALTHY LIVING AS BABY 

BOOMERS AGE 

FIELD HEARING 

BEFORE THE

SPECIAL COMMITTEE ON AGING 

UNITED STATES SENATE 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

PUEBLO, CO 

AUGUST 27, 2010 

Serial No. 111–23 

Printed for the use of the Special Committee on Aging 

( 

Available via the World Wide Web: http://www.gpoaccess.gov/congress/index.html 

SPECIAL COMMITTEE ON AGING 

HERB KOHL, Wisconsin, Chairman 

RON WYDEN, Oregon 

BLANCHE L. LINCOLN, Arkansas 

EVAN BAYH, Indiana 

BILL NELSON, Florida 

ROBERT P. CASEY, Jr., Pennsylvania 

CLAIRE McCASKILL, Missouri 

SHELDON WHITEHOUSE, Rhode Island 

MARK UDALL, Colorado 

KIRSTEN GILLIBRAND, New York 

MICHAEL BENNET, Colorado 

ARLEN SPECTER, Pennsylvania 

AL FRANKEN, Minnesota 

BOB CORKER, Tennessee 

RICHARD SHELBY, Alabama 

SUSAN COLLINS, Maine 

GEORGE LeMIEUX, FLORIDA 

ORRIN HATCH, Utah 

SAM BROWNBACK, Kansas 

LINDSEY GRAHAM, South Carolina 

SAXBY CHAMBLISS, Georgia 

DEBRA WHITMAN, Majority Staff Director 

MICHAEL BASSETT, Ranking Member Staff Director 

(II) 

C O N T E N T S 

Page 

Opening Statement of Senator Mark Udall ........................................................... 1 

PANEL I 

Statement of Kathy Greenlee, Assistant Secretary for Aging, U.S. Department 

of Health and Human Services ........................................................................... 4 

PANEL II 

Statement of Stephen G. Nawrocki, Executive Director, Valley Humane Resource for the Disabled, Pueblo, CO ................................................................... 23 

Statement of Paul Downey, President, National Association of Nutrition and 

Aging Services, and President, California Nutrition Coalition ........................ 29 

Statement of Guy Dutra-Silveira, Director, Pikes Peak Area Council of Governments Area Agency on Aging ........................................................................ 35 

Statement of Dace Carver Kramer, Aging Well Program .................................... 41 

(III) 

(1) 

REAUTHORIZING THE OLDER AMERICANS 

ACT: ENCOURAGING HEALTHY LIVING AS 

BABY BOOMERS AGE 

FRIDAY, AUGUST 27, 2010 

U.S. SENATE, 

SPECIAL COMMITTEE ON AGING, 

Pueblo, CO. 

The committee met, pursuant to notice, at 11:05 a.m. in the 

Cottonwood Room, Colorado State University, 2200 Bonforte Boulevard, Pueblo, CO 81001, Hon. Mark Udall, presiding. 

Present: Senator Udall [presiding]. 

MODERATOR. Good morning, everybody. I’d like to welcome you 

here to the city of Pueblo and the CSU Pueblo Campus. I’m pretty 

proud of this facility. I’m an alumni of the university. 

At this time I’d please ask you to stand for the Pledge of Allegiance. [Pledge of Allegiance.] 

Thank you. I’m also proud today to introduce our U.S. Senator 

from the State of Colorado Mark Udall. Senator Udall is on several 

important committees representing this great state. He’s on the 

Armed Services Committee, Committee of Energy and Natural Resources, and the Special Committee on Aging. In addition to those 

special committees, Senator Udall chairs the National Parks Subcommittee. 

So, Senator Udall, welcome to Pueblo. [Applause.] 

OPENING STATEMENT OF SENATOR MARK UDALL 

Senator UDALL. Thank you, Jerry, and it is wonderful to be here 

in Pueblo. I want to welcome all of you in the audience. We’re 

going to have a very informative hearing, of that I have no doubt, 

this morning, and in that spirit, the Special Committee on Aging 

will come to order for this important field hearing in the great city 

of Pueblo in the even greater state of Colorado. 

I have an opening statement I’d like to share with everybody and 

then we’re going to hear from our first panelists. We have about 

2 hours scheduled and there will be some time during the second 

panel for questions to come from the audience, as well. I’m very 

much looking forward to hearing what all of you may have to say 

and the questions you may want to direct at the second panel. 

I’m very appreciative that the Chairman of the Committee, Senator Herb Kohl from Wisconsin, has loaned me his gavel to bring 

the focus of this panel back home to Colorado, and I want to also 

again say how grateful I am that so many of the panelists are here 

on this beautiful Friday morning. 

2 

Ms. Kramer, I know you’ve come all the way down from Oak 

Creek to be here and, Mr. Downy, I’m sure you’ve given up what’s 

a sunny day in San Diego to be in an even sunnier environment 

here in Pueblo. It’s a testament to your enthusiasm and your commitment to this very important topic. 

Assistant Secretary Greenlee, you’ve traveled the farthest to join 

us today. I should tell you the Secretary told me that it’s not heavy 

duty to come to Colorado but again I want to thank you for giving 

us the opportunity to showcase the great services and programs of 

the aging community right here in Colorado. 

It’s a special treat to be able to hear directly from you about the 

reauthorization of the Older Americans Act and to have you as a 

captive audience for our local organizations to both brag about 

their successes but also so they can give you their unique perspectives and some recommendations in the process. 

I know you’ve hit the ground running since you were confirmed 

as Assistant Secretary for Aging and I’m confident that the Administration on Aging is being steered by an able and fresh-thinking 

leader at a time when services for our seniors are more critical 

than ever. 

Now we’re all here today to talk about strengthening a very important law which has provided essential services for our nation’s 

seniors since 1965, the Older Americans Act. The core mission of 

the OAA has been consistent over the years. Let me do quick math. 

1965 to 2010, is that 45 years? That mission has been helping our 

more life-experienced friends, life experienced in quotations, loved 

ones and neighbors maintain their independence in their homes 

and their communities, promoting a continuum of care for the most 

vulnerable among us. 

Over the past 45 years, OAA has been improved, modified, and 

expanded, but its core mission has remained steadfast, and it has 

developed a strong aging network represented by many of you in 

this room here today, reaching across the country, in every region 

of every state, to serve as the backbone of the critical services it 

provides. 

The bill, as many of you know, OAA is up for reauthorization and 

for those of you who don’t do Washington speak, that means it’s 

time to give the law another look and figure out how we can improve it. 

With this reauthorization, I believe we have a great opportunity 

to modernize the Act for a new and unique generation of seniors. 

You are all familiar, I’m sure, with the staggering task we have before us in terms of serving the approaching wave of seniors. 

The baby-boom generation, which I’m a member, I admit, I’m 

even on the right side of 60 now but that’s another topic, starts to 

turn 65 next year and the percentage of our population in this demographic is growing rapidly. By 2020, one out of every six Americans will be 65 years of age or older. 

These Americans fast approaching Medicare eligibility are truly 

of a different generation with different experiences and holding different expectations about what their golden years should be. 

Now I’ve asked our panelists today to focus their remarks on how 

we can improve OAA from a prevention and wellness perspective. 

If the charge of the Older Americans Act is keeping seniors indeVerDate Nov 24 2008 15:07 Feb 01, 2011 Jkt 000000 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 H:\DOCS\63678.TXT SAG PsN: JOYCE
3 

pendent, healthy, and in their communities, we can’t be successful 

without focusing on proven disease prevention and health promotion programs. 

Madam Secretary, I want to brag. Colorado is the healthiest, 

slimmest, fittest state, but we want to remain that way, regardless 

of the age of our citizens. 

Now to serve this rapidly growing group which is more diverse 

and unique than ever before, we are lucky to have the Aging Network to rely on and what I think is great about this network and 

the services currently provided by the Older Americans Act is the 

flexibility it gives states and local entities to provide the distinctive 

needs of their communities. 

One size fits all doesn’t work very well here in Colorado and it 

certainly isn’t going to work for my generation of baby-boomers. 

So I hope that maintaining this spirit of flexibility remains a priority as discussion of reauthorizing the Older Americans Act continues and I’m curious to hear from all of you today how we might, 

from the Federal level, provide AAAs and providers with even 

greater ability and charge to be innovative and effective with their 

resources because leveraging resources is going to be key moving 

forward as it is across all spectrums of government and the private 

sector, and I hope we can find better ways of using what we have 

to make OAA programs work better and for more seniors. 

Forming effective partnerships with communities, local businesses, governments, and the private sector needs to be a central 

part of these efforts, and I know many of you who are here today 

have become experts at finding inventive ways of working together 

to achieve impressive results. 

I want to hear those stories and I want you to tell us how we 

can help break down any barriers that exist on the Federal level 

from being even more successful. 

With that overview, let me make a few comments about the format of the hearing. As I mentioned, we’re first going to hear from 

Kathy Greenlee, who serves as the Assistant Secretary of Aging at 

the U.S. Department of Health and Human Services. She’ll speak 

about the Administration on Aging’s ongoing efforts with regard to 

OAA reauthorization and once she concludes her remarks, I’m 

going to ask a few questions of her and she may even have questions of me. We’ll see what results. 

Then we’ll take a quick break prior to inviting the second panel 

to take their places and provide their testimony. I’ll do a similar 

question and answer session with them and then hopefully we’ll 

have time and then I’ll be able to open it up to the audience here 

to ask questions of the second panel. So the second panel should 

be ready for questions not just from me but from the audience, as 

well. 

So, Assistant Secretary Greenlee, with that, if you’d join me up 

here, we have a placard and a microphone, and as you take your 

seat, let me just tell the audience a little bit more about Ms. 

Greenlee. 

She was appointed by President Obama to serve as the fourth 

Assistant Secretary for Aging, a post she’s held since her Senate 

confirmation last June. She brings over a decade of experience 

4 

working in different capacities to keep seniors healthy and happy 

and I’m very pleased she’s able to be here today with us. 

Assistant Secretary, please proceed with your testimony. 

STATEMENT OF ASSISTANT SECRETARY KATHY GREENLEE, 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Ms. GREENLEE. Thank you very much, Senator. Happy birthday. 

As someone who works in the field of aging, I did notice that you 

turned 60 last month. I turned 50 in March and we represent, I 

think, the spectrum of baby-boomers, the two of us, all committed 

to doing this work. 

So I’m very pleased to be here with you today, to be in Colorado. 

I grew up in Kansas, lived there most of my life, and so I feel close 

to home when I come here. 

It’s an honor to be able to testify before the Senate Special Committee on Aging and I will do the same with your committee chair 

in a couple weeks up in Milwaukee, and it’s nice to be here also 

to hear the testimony of my colleagues from Colorado. 

I will promise you we are not strangers, that I have worked 

closely with the Colorado network, have been in Colorado before, 

and I’ve taken the opportunity to see services that are delivered 

here. You have the right to be proud and I’m aware of that. 

So I want to thank you for having the hearing, and I commend 

you on your leadership. The reauthorization is unique and as we 

face, as you mentioned, the first boomers turning 65. Universally, 

since I became Assistant Secretary, people have indicated that they 

think this reauthorization is special. It’s the opportunity to really 

be visionary and look at the future about what we need to do to 

strengthen the capacity of this network while still, maintaining the 

common goal of helping to serve as many seniors as we can and 

helping them stay independent. 

I want to acknowledge Todd Coffey, who’s here. Todd’s the director of your State Unit on Aging. We had just been talking beforehand. Todd and I had a bonding experience when we got our flu 

shots together last year in Denver. So we know each other well and 

it’s very nice to be here with Todd, as well as many members of 

your aging services network, area agency directors and so forth, 

that are here. You have good strong leadership in Colorado and you 

should certainly be proud. 

The trick this morning in talking to you is to figure out how best 

to be succinct and also demonstrate the depth of my commitment 

to these programs and so I’m quite willing to answer questions and 

respond as I can. 

You pointed out that the Older Americans Act was passed in 

1965, and it was. President Johnson signed it into law and it is actually older than Medicare and Medicaid by 16 days. Those three 

laws passed together are really a triumvirate that were passed 45 

years ago of services meant to blend together to support seniors. 

In thinking about the differences between Medicare and Medicaid and the Older Americans Act, the beauty of the Older Americans Act is it was never intended to be an entitlement. It was always intended to be flexible. So I anticipate flexibility will be a 

theme. That certainly is the way this law has always been designed 

and always been delivered, so looking at the future on what other 

5 

flexibilities we can provide is quite appropriate. It’s really what the 

law is supposed to do. 

In 1965, there were 26 million Americans aged 60 and over and 

today there are 57 million. We know that there are many more seniors on the horizon. As you mentioned, the population is not only 

growing but it’s becoming more diverse. Everybody, as they age, 

has the same simple goals and that’s to be able to remain in their 

community, in their homes, with their families for as long as possible. Those of us who do this work understand that one of the critical partners in supporting seniors as they age are their caregivers, 

because caregivers are 80 percent of the backbone of the long-term 

services that we have. 

Most people are cared for by their loved ones and that has never 

changed. It needs to be recognized as we move forward, that we 

will need to have an infrastructure that supports caregivers and 

continues to support the growing aging population. 

I believe that the enactment of healthy care reform, known as 

the Affordable Care Act, is as significant for seniors as those three 

laws were in 1965. This gives us an opportunity to focus on our 

aging services network, to focus on the health and the lives of older 

Americans, and to figure out how we can best take advantage of 

the expertise that we have gained over the past 45 years on how 

to support healthy living and longevity in the community. 

We are looking for those opportunities, are engaged and excited 

by the opportunities that health reform has brought to this particular network. 

What I have done with regard to the reauthorization is to hold 

a series of listening sessions. I did a listening session in Dallas, TX, 

I did one in Alexandria, VA, and one in San Francisco. We heard 

from over 400 people who gave us written comments, over 300 

showed up at these hearings in person to testify. They had 3 minutes apiece to testify and they came quite long distances to give us 

information about all of the services that we have under the Older 

Americans Act. 

What I can share with you today are some of the things I heard 

at the sessions, and what I would expect that you would hear 

today. One is a strong commitment to the structure of the area 

agencies and this network with regard to being a single point of 

entry for information and referral. This is the backbone of the national structure that we have created for being able to access services, whether they’re health promotion services, or basic information about supports in the community. 

A strong commitment to self-directedness is a core value of the 

Older Americans Act, that the programs and the services are tailored to the needs of each single person. Unlike Medicare and Medicaid, you don’t get the package, you get what you need and that’s 

a big difference. 

Flexibility, especially with regard to nutrition, came up quite a 

lot in the public hearings. Integration of medical services and 

health services comes up a lot when you talk about chronic disease 

and disease management. In other words how can we use the best 

of science and the best of social science to provide better outcomes, 

as well as concern about workforce and workforce development? 

6 

Even though 80 percent of long-term care in the U.S. is provided 

by caregivers, we will need increasing numbers of paid professionals and paraprofessionals to care for our growing numbers of 

seniors. Also, I had the pleasure of hearing testimony from Native 

Americans about the Title VI Programs. I was clear in my testimony we’re talking about reauthorization, not reappropriation, that 

there’s a difference between the law and the money that funds the 

Title VI programs. When we talk about Title VI, it’s almost impossible to separate the two. Programs for the tribes are simply small 

and it’s very difficult for tribal organizations to make an impact 

with the dollars because the amounts they have are so small. So 

we’re looking for opportunities to be innovative and work with 

tribes. 

I would like to just briefly run through the themes based on the 

specific titles of the law. The first title of the Older Americans Act 

is the guiding principles and those have not changed. It’s the goal 

of enhancing the lives of older Americans. I don’t anticipate we 

need to change that at all. 

The second title of the law is about the importance of advocacy. 

Unlike many other laws, there’s a statutory charge at the Federal 

level that we advocate on behalf of older Americans at every level, 

that the Assistant Secretary advocate, that the state directors advocate, and that the AAAs advocate, and this is not the same thing 

as lobbying. It’s about giving voice to the concerns of the people 

that we serve. We are charged with that responsibility and proud 

of that and we must continue, I think, to be advocates. 

Title III is where we serve most of the programs. It’s where the 

home- and community-based services are, and where the nutrition 

programs are. We heard strongly about the need for two things: innovation and flexibility. 

I heard a lot of input about nutrition, about whether or not we 

should consider combining congregate and home-delivered meals 

into one category, so that the States can be more attentive to the 

needs of their local communities and be more innovative with nutrition programs. We heard a lot of testimony from States about 

the need to be flexible with the other services, as well, so that they 

can meet the specific needs of individuals. 

We heard also about the importance of our network in terms of 

being a single point of entrance, a single point of information, both 

through the interagencies and also through the aging and disability 

resource centers, which are a joint program between the Administration on Aging and the Centers for Medicare and Medicaid Services. So, as we move forward and look at what we can do, those 

will be the core things that we move upon. 

We need to have a broader range of evidence-based interventions. 

We are committed at AOA to evidence-based programming, which 

means that if we are going to provide services, we must show 

health outcomes. We need to continue to support various types of 

kinship care for caregivers because with all kinds of families supporting each other, the family definition needs to be flexible and we 

certainly have grandparents raising grandchildren. 

Then because I have driven from Denver to Kansas more than 

once, I am interested in and concerned, as you are, with rural 

issues and our inability to reach seniors in every location, both 

7 

rural and frontier. We have an Older Workers Program in the 

Older Americans Act that is administered by the Department of 

Labor. I had a joint webinar with the Department of Labor to take 

input on this program. 

If you have an interest as you move forward to take testimony 

on Title V, we’re quite willing to work with you to make sure that 

our colleagues at the Department of Labor get that input from you, 

as well. 

Finally, it was clear in my listening sessions about our need to 

focus on elder rights, where we have a new opportunity. Title VII 

of the Older Americans Act has always embodied elder rights, elder 

justice, and the opportunity to address elder abuse, as well as the 

long-term care Ombudsman Programs. 

This is where we fund legal services and other opportunities. 

Since Congress has now passed with health reform the Elder Justice Act, we are looking at how we can best marry these programs 

together, making sure that the Older Americans Act reauthorization picks up the very best of the Elder Justice Act so we can establish integrated services as we move forward. It’s a wonderful time 

to be doing this particular work because we have so many knowledgeable people. This network will work with you and provide you 

with as much information as you want because they’ve been paying 

attention to both the reauthorization and health reform as it’s been 

passed. 

So it’s wonderful to be here with you today. We look forward to 

collaborating. I can come see you at a closer venue, if you need 

more engagement in D.C., and quite willing to come to Colorado. 

My sister lives here and I’ve always had as many family members 

living in Denver or the Colorado area as I have in Kansas. So I’ll 

come visit with you in Colorado or Washington or wherever I can 

to help you do what you need to do and what we need to do as a 

nation to really support seniors as they age. 

Thank you. 

Senator UDALL. OK. Thank you, Secretary Greenlee. You were 

better prepared and talked into the mike which I didn’t do, so I 

hope you all can hear me better at this point. 

Thank you for that both thorough and very succinct outline of 

both the successes and the opportunities in the future with OAA. 

I would also thank the Secretary for her acknowledging that at 

one point the State of Colorado was part of the territory of Kansas 

and there are Kansans who want us back but the Secretary didn’t 

make that request. 

Ms. GREENLEE. No. [Laughter.] 

Senator UDALL. Is the Chieftain here? 

Ms. GREENLEE. I’m going to take the Fifth Amendment. 

Senator UDALL. Well, let me start and we have, oh, about 10 

minutes or so here for some questions. 

One of the current themes is the question of rural care and we 

have a lot of rural in Colorado. 

Ms. GREENLEE. Yes, yes. 

Senator UDALL. The Plains, even along the front range, there are 

a lot of small wonderful little communities and a bunch of rural 

communities, and, of course, you get into the mountains and the 

plateau and Mesa Canyon Country of Western Colorado. 

8 

What have you heard in your listening sessions about the best 

ways to get evidence-based treatments and approaches and prevention programs into these rural communities? Could you expound on 

that a bit? 

Ms. GREENLEE. Even though there are issues in rural areas, we 

need to keep in mind there are people, providers and systems 

there. It’s imperative to be successful in delivering services to seniors that those systems work together and that we be able to integrate service delivery on the ground and take advantage of what’s 

there. 

I certainly hear testimony about the opportunities for technology, 

for telemedicine and for distance learning. This topic came up for 

me when I was the Secretary of Aging in Kansas, as well, and since 

I came to Washington. 

I think we need to pursue that, but I think we also have to look 

at the unique nature of the rural region and do targeted outreach. 

The Older Americans Act has specific categories that we must 

reach. While it’s not an entitlement, there are targets that we have 

to reach and isolation and underserved areas are one of those targets. 

What came up when I was hearing testimony was whether or not 

we needed to add an additional category for frontier. There are 

rural areas and frontier areas and I certainly know the difference, 

but that’s not necessarily the case. There are people living in very, 

very remote circumstances. 

Senator UDALL. Frontier? 

Ms. GREENLEE. Frontier, very, very remote, and if you go north 

of here, if you go to the Northern Plains, Wyoming, Montana, you 

can really think about people who are hundreds of miles from these 

services, and what is the best way that we can target those individuals? 

As you know, time and distance are expensive and one of the 

challenges for us moving forward is to figure out whether or not 

the funding that we provide should take into consideration the cost 

of providing services to the frontier. 

Our urban friends will talk about their density which also creates issues for them. So I think we just have to look at what the 

best way is to be specific and targeted and realize there are different needs there. As we know and I certainly know this as a Kansan, there are rural areas where the average age is much higher 

in their counties than in urban areas, that we have younger people 

who moved away from rural parts and from the country and those 

seniors can be particularly vulnerable. 

Senator UDALL. One of the interesting developments, although 

it’s not reached the level of large-scale development, is some seniors moving to towns east of Denver because they’re safe communities, the cost of housing is reasonable, it’s much easier for their 

children to visit them with their grandchildren in these places, 

traveling to the east an hour or two versus an hour to the mountains or to the west, and, interestingly, there may be draw into 

some of these smaller and still interesting communities for seniors 

and the baby-boomer generation, particularly as we also look at our 

assets and income streams we have and need to find areas where 

9 

the cost of living is something we need. I just offer that as an observation. 

Ms. GREENLEE. Senator, if I didn’t mention transportation specifically, Title III(b), the supportive services that we have, a large 

percentage of that goes to fund transportation. The issue of transporting seniors to doctors’ appointments and to their families, is 

huge and growing. It is much broader than something that can be 

resolved through the Older Americans Act alone. 

Transportation is not just a rural, issue but also an urban issue. 

It will continue to be a theme as we try to address increasing numbers of seniors. If the nation’s goal is to help seniors live at home, 

then their engagement in their communities will be dependent 

upon a transportation system that probably needs to also be innovative and involved. We all need, I think, to have good partners in 

transportation who can help us figure that out. 

Senator UDALL. Another item for Secretary Lahood—— 

Ms. GREENLEE. Yes, it’s huge with regard to transportation. 

Senator UDALL [continuing]. For the Department of Transportation, as well. 

You mentioned again the need for innovation—— 

Ms. GREENLEE. Yes. 

Senator UDALL [continuing]. In your listening sessions, could you 

share a couple of ideas when it comes to nutrition, wellness, and 

prevention that you hadn’t thought of or you hadn’t heard about 

but that popped out, as you talked about, the people on the ground 

being creative? 

Ms. GREENLEE. There is an outdated image of seniors that they 

go to a congregate meal site, have a meal and go home. That model 

of senior engagement and senior centers is disappearing, fortunately, and I have been—— 

Senator UDALL. Did you say fortunately? 

Ms. GREENLEE. Fortunately, I have had the opportunity—and 

Paul Downey is going to testify from San Diego so I just recognize 

San Diego in particular for their efforts. 

I had the opportunity to be at some local senior centers where 

their ability to pull multiple funding streams together and their 

ability to provide comprehensive support to centers is astonishing. 

The ability to not just provide a meal but to do wellness interventions and support, to provide programming for diverse communities, to be the 2–1–1 system, the information referral system, in 

San Diego. 

There are some wonderful places where senior centers in particular and area agencies have been able to figure out how to bring 

services to the location so that as a senior comes they can be supported in their health, their social engagement, and in their meals. 

I’m quite happy and willing to partner with the National Association of Area Agencies on Aging to promote their best practices. 

There are simply phenomenal places in this country providing very 

unique services. 

I was at a senior center in New York City and was impressed 

by what they had done in terms of working with other populations. 

They were the only senior center I’ve been to where the volunteers 

providing meals were teenagers with developmental disabilities, 

and this was a way to provide different and unique programming. 

10 

I’ve been to a location in Washington where there are adult day 

services and services for children with disabilities, as well as children without disabilities all in the same location. That’s where the 

innovation is taking place and as much as I love State government, 

have come from State government, the innovation of this network 

needs to be supported by us at the State and Federal level. It happens on the ground and it’s quite exciting. 

Senator UDALL. Most great ideas happen on the ground. 

Ms. GREENLEE. We need to support it. 

Senator UDALL. It sounds like, as well, these organizations and 

these individuals are finding ways to stretch dollars in particularly 

tough economic times. 

Ms. GREENLEE. Yes. 

Senator UDALL. There’s always a need for additional resources, 

but you haven’t mentioned dollars once which is impressive. 

Ms. GREENLEE. I only mentioned them when I talked about Title 

VI. I was very clear in the listening sessions that these are two different initiatives. My charge and my instruction to the network is 

let’s look at the law and figure out what’s in the way, what we 

need to improve on, and then we need to return to the conversation 

on appropriations and we must do that. 

Senator UDALL. Sure. I mentioned in my remarks that the babyboom generation is unique and I wanted you to expound a little bit 

on what you learned in your listening sessions and I do that, while 

apologizing to some of the younger Americans who are here who 

are sick of hearing about the baby-boomers, I’m sure, but we are 

a large group. 

At some point we’ll be gone and you’ll have America all to yourselves, but in the meantime we are quite a cohort. We have had 

our own set of life experiences, parents of those who were the 

Greatest Generation, lived through the 1960’s and 1970’s and now 

into the 21st Century. 

What sorts of insights have you generated as to the unique perspective and needs and expectations of the baby-boomer generation? 

Ms. GREENLEE. In doing this work, I have a particular phrase 

that I really find disdainful. I don’t like the phrase ‘‘silver tsunami.’’ I do not see the—— 

Senator UDALL. What was the phrase? 

Ms. GREENLEE. Silver tsunami. 

Senator UDALL. Silver tsunami. 

Ms. GREENLEE. I do not like the phrase and it’s coined from the 

sense that the resources that we will need will be this huge burden 

that will engulf us as we address the needs of the baby-boomers. 

I think that is both limited and sad to have that approach. 

More and more, as I talk to people and I’m on the young end of 

the baby-boom generation, I think what will happen is that the 

boomer generation will completely define or redefine what aging is. 

Many authors and theorists in the field of aging who talk about a 

third chapter, that is we have increased longevity and a ‘‘sweet 

spot’’ of the healthy years have been pushed out to a later date. We 

still will have decline in old age, but people in the 50 to 75 age 

range which is where the boomers now fall, have more social capital, have more innovation, have more creativity and opportunity to 

11 

give back to this country than ever before. So this is not just a 

drain in terms of what are we going to do when they’re 90, but 

what can we do to harness the creativity and energy of boomers 

right now? I think that boomers themselves will redefine for us 

what they need to stay in the community. They will help us figure 

out transportation and other issues that are very hard. 

Retirement is a phrase I don’t even understand anymore and certainly boomers don’t know what to call themselves, as well. So 

they’ll probably always be boomers because they don’t like the term 

senior. I do think that this cohort will change the way that we provide services for the better and that we will have better nursing 

home care. We will have more persons in our care in every setting. 

We will be able to find the best way to provide the lightest touch, 

the least expensive support, and then progress to more supports as 

someone becomes more frail and disabled. 

I think it’s a time of hope and opportunity for boomers and it’s 

a very, very exciting time to be in the field of aging. 

Senator UDALL. What you just said is illustrative of why you’re 

such an important part of this effort and why you were chosen—— 

Ms. GREENLEE. Thank you. 

Senator UDALL [continuing]. It’s very inspiring to hear you talk 

on this because I’ve actually got goose bumps. 

Ms. GREENLEE. Thank you. 

Senator UDALL. I think that you’re right, that the baby-boomer 

generation has an opportunity to give back to a very rich back nine 

of life, if you will,—— 

Ms. GREENLEE. Yes, yes. 

Senator UDALL [continuing]. If you’re a golfer or however way 

you want to characterize what’s in front of us here. 

There’s also an opportunity to be of public service, dedicate yourself to causes greater than your own self interests, and I think that 

motivates many, many people as they age, as they get a little 

longer sense of history in their own lifespans. So that’s the opportunity that is in front of us. 

I’m tempted to end there, but I want to ask you one last question—— 

Ms. GREENLEE. Sure. 

Senator UDALL [continuing]. Which is more specific. 

Ms. GREENLEE. Sure. 

Senator UDALL. I want to get on my question specifically. You 

talked about the recently passed health reform law—— 

Ms. GREENLEE. Yes. 

Senator UDALL [continuing]. Boy, you missed some great town 

meetings here a year ago. 

Ms. GREENLEE. Oh, yes. 

Senator UDALL. I had a big one in Durango that went very well, 

given there were only 18 state troopers, sheriff deputies and multiple police there to protect me and everybody else from themselves. 

But setting that aside, when you mentioned the recently passed 

healthcare reform law and how the aging network will be called 

upon to complement and support and enhance the coming improvements to the healthcare delivery, much as it did during the 

changes to the Medicare Prescription Drug Benefit, however this 

12 

time the policy’s on a much larger scale, can you speak a little 

more on how you envision the aging network playing such a role, 

both via the services and the infrastructure that it provides? 

Ms. GREENLEE. You referenced Medicare Part D, so in terms of 

education and information? 

Senator UDALL. Yes, yes. 

Ms. GREENLEE. I’m going to broaden my answer a little bit beyond your question. 

Senator UDALL. Sure. 

Ms. GREENLEE. I think the greatest opportunity for this network 

in health reform is what I call the gray area between the medical 

model and the social model, between opportunity to look holistically 

at an individual and say what do you need. 

In a conversation about hospital discharge and readmission that 

was so much a part of the conversation—— 

Senator UDALL. Oh, sure, yes. 

Ms. GREENLEE [continuing]. Of health reform, some of that conversation was about payment systems for hospitals, but many of us 

who work with seniors understood is that it’s also about what happens when the person returns home. What we find are tremendous 

opportunities that are funded in health reform to look for innovative ways to work on care transition, care coordination, medical 

homes, that this network has a value to bring to the table. 

There are some challenges in doing that. We didn’t build a medical system and a social system that have the same database. So 

what we need to do is go back to the innovative practices in our 

field and say, look, here is the most holistic integrated model we 

can have in the community so that we have the best of the medical 

system, the best of the community supports, a recognition of the 

role of the senior and their caregiver, and we come up with all of 

the right combinations so someone is healthy and has a good quality of life and has good health. Those, I think, are the greatest opportunities. 

With regard to education, I think the greatest role that our network can have is to provide some basic information, to overcome 

some of the misinformation about health reform, Medicare and 

what’s going to happen in the new prevention benefits. We can continue to assist seniors in many of the ways by providing information that addresses that we have been to overcome some of their 

concerns. 

But I think the network’s stake in this case is about the opportunity to provide innovation, so that we can expand community 

services that are more integrated with our health care systems. I 

think that is the deliverable that the aging network has an opportunity to provide. 

I also think that the Class Act that was passed in health reform 

is an important program, the Class Act is a new national voluntary 

long-term care insurance program included as a part of health reform. In a nutshell, workers can volunteer to park some of their 

own money, kind of like in a 401(k), in an account to help support 

their own independence when they become disabled. 

It’ll take roughly 10 years before anyone can receive those benefits, but at some point the Class Act represents an opportunity to 

find different kinds of funding so that seniors can have suppleVerDate Nov 24 2008 15:07 Feb 01, 2011 Jkt 000000 PO 00000 Frm 00016 Fmt 6633 Sfmt 6633 H:\DOCS\63678.TXT SAG PsN: JOYCE
13 

mental support to stay independent and that will also impact this 

network. 

We have capacity opportunities to grow so that we can meet the 

needs of seniors. This growing number of baby-boomers provides 

phenomenal opportunities for the network. 

Senator UDALL. So you referenced the EMR and I was admonished by my great staff here to not let you use lots of acronyms. 

Ms. GREENLEE. Which one did I use? 

Senator UDALL. Yet I’ve used them here. EMR, electronic medical 

records, which is an important part of the Healthcare Reform 

Act,—— 

Ms. GREENLEE. Yes. 

Senator UDALL [continuing]. I think you were saying that could 

be an important part, access to that information, maybe even expanding it to the OAA application and programs here moving forward. 

Ms. GREENLEE. Yes. When you think about the life of a senior 

and their transitions, especially when they need support they go 

from home to the hospital to skilled rehab and maybe some community services. The ability to translate and transport data and information across those settings is critical to having good quality 

outcomes. So as we look at electronic medical records, the social 

support system must eventually also be added to that system so 

that the information is complete about any one individual and their 

status. 

Senator UDALL. That would include basics like where you live, 

your transportation options. 

Ms. GREENLEE. Whether you have a caregiver because your caregiver may be the one who’s helping with your medications. 

Senator UDALL. Whether that caregiver’s a family member. Certainly there could be privacy concerns, but I think there’s obviously 

things that add value to it and utilizes the technology that has 

been developed in the last 20 years in the country, one of our 

strengths, by the way, in the infrastructure that would apply. 

I could listen to you, as I’m sure everybody here, for quite a bit 

longer. I do think we’ve reached the point where we—— 

Ms. GREENLEE. Thank you. 

Senator UDALL [continuing]. Need to take a short break. Once 

again, I can understand why Secretary Sebelius trusts you, leans 

on you, and it’s obvious to me you’re also very much involved in 

implementing the Affordable Care Act, and thank you for that good 

work. 

I know history, I’m going to editorialize here, history will show 

what the Congress did over this last year in broadening coverage, 

including every American, in our healthcare system with the intent 

of maintaining quality and driving down costs was the right thing 

to do, and I look forward to working with you to implement that, 

as well. 

Ms. GREENLEE. Thank you very much. Thank you, Senator. 

[The prepared statement of Ms. Greenlee follows:] 

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Senator UDALL. Thank you for being here, Secretary. 

Ms. GREENLEE. Thank the rest of you. 

Senator UDALL. We’ll take a 10-minute break and in the meantime, I know Jake Swanton is here. Everybody should know, make 

sure that the next group of panelists take their seats, and then I’ll 

introduce the next group of panelists in about 10 minutes and we 

look forward to your testimony, as well. 

Thank you very much. 

[Recess.] 

Senator UDALL. The Special Committee on Aging will come back 

to order. Although I didn’t recess formally before, I’ll call us back 

in to order. 

I understand my mike is not as loud as Assistant Secretary 

Greenlee’s was. So I’ll try and speak into it so everybody can hear 

me a little better. 

I want to ask the second panel to come up and take their seats 

and when they’re seated, I’ll then make a series of quick introductions and then we’ll hear from them. So if you all would come up 

and join us? 

All right. I want to thank this group for joining me here today, 

as I have before, and I know that Assistant Secretary Greenlee’s 

remarks gave greater understanding of what the Administration’s 

goals are for improving senior services and I hope they gave everybody else here a great backdrop for our next panel. Thanks again 

to the Assistant Secretary. 

Our next panel is made up of local and national leaders on aging 

services and policy. They have bios in your program, but I do want 

to thank and acknowledge them beginning our second panel and 

ask them to join me up front as they’ve already done. 

Steve Nawrocki is the executive director of the Senior Resource 

Development Agency here in Pueblo. Steve has served here in 

Pueblo since 1978 and will be able to give us a greater perspective 

on the needs and the work being done here in Pueblo. So thank 

you, Steve, for being here. 

Paul Downey is the president of the National Association of Nutrition and Aging Services Programs and, as I’ve already mentioned, traveled all the way from Southern California to be with us 

here today. He also heads up the very successful programs of senior community centers in San Diego and will be able, I believe, to 

add some additional input on how to replicate the successes across 

the country. 

Guy Dutra-Silveira is currently the director of the Pikes Peak 

Area Council of Governments, Area Agency on Aging. I know that’s 

a mouthful, but it’s important work, and in addition to being an 

impressive musician, I understand Guy’s policy perspective will 

help guide our discussion on our region’s needs and how the Older 

Americans Act can deliver for Colorado, including our veterans, 

given the importance presence they have in the Springs. 

Dace Carver Kramer is the special consultant to the Northwest 

Colorado Visiting Nurses Association. As many of you know, the 

VNAs across the country are often the tip of the spear, if you will, 

on aging policy. Her 40+ years of work in the legislative and nonprofit environments will be a great addition to our discussion, especially her work in rural areas. 

23 

I want to thank each of our panelists once again for being here. 

We’re going to begin with opening remarks. I hope you can keep 

them to 5 minutes, and then we will begin discussion and hopefully 

I want to get to some questions from our attendees. 

I mentioned earlier acronyms and numerical titles of the Older 

Americans Act, they may not mean a lot to our guests here. So if 

you have a little voice in the back of your head for the benefit of 

the people here, please explain when you mention a title, whatever 

it may be, or the acronyms, it would be helpful. 

So thank you, and we’ll turn it to Steve. The floor is yours. 

STATEMENT OF STEPHEN G. NAWROCKI, EXECUTIVE DIRECTOR, SENIOR RESOURCES DEVELOPMENT AGENCY, PUEBLO, 

CO 

Mr. NAWROCKI. Well, thank you, Senator, and also it’s a real 

honor to be able to here today and to be asked to be part of this 

panel and I would certainly like to welcome Assistant Secretary 

Greenlee to Pueblo, CO, not only as a director of a nonprofit agency 

that serves seniors and has a lot of Older American Act programs 

but also as a city councilman, and I would like to also welcome the 

rest of the distinguished panel. 

I feel a little bit humble here. I’m just a little direct service provider and all of you have all these great things that you’ve been 

involved with. So it’s a real privilege to be a part of it and also 

today is the kickoff of the State Fair. So we’re checking to see if 

you’ve got your jeans and cowboy boots on. I see the Senator has 

his boots on, so that’s good. 

Senator UDALL. I’ve got a pair of jeans to change into later. 

How’s that? 

Mr. NAWROCKI. I did have an opportunity to put together with 

some of my colleagues from the Senior Resource Development 

Agency, and I’ll refer to it as SRDA, just to keep in line with Jake, 

that we met—when he informed me that I had to submit some kind 

of a narrative that would be put into the record, I got together with 

our colleagues and we did some of that and I’m not necessarily 

going to talk about anything that we submitted for the record, but 

he did ask me to talk a little bit about the Pueblo area because it 

is unique in terms of it is urban and rural, even though the northern part of the state still considers Pueblo rural. 

We are a city of about a 105,000. We have an art center and we 

have a lot of things going on in our community. The county is 

about a 155,000. It’s a very diverse county, and I think that’s one 

of the things that makes us such a great place to live. 

Almost 19 percent of our population is 60 years of age or older. 

That’s quite a high percentage of seniors living in our county. The 

state average is somewhere in the area of 12 percent to 13 percent. 

I think the national average is somewhere in the area of 15 percent. So we do have an aging population in Pueblo. People seniors 

choose to stay here and not leave our area and I think a lot of it 

has to do with the cost of living and the climate and just being a 

great place to live and the traditions of our community. 

What I’m so excited about is listening to Assistant Secretary talk 

about what she sees as kind of the future in terms of senior services, a focal point, a place where there is like one-stop shopping, 

24 

and I know our colleague here from San Diego, after reading the 

information, that’s exactly what’s happening in your community, 

except you really are a large community compared to our community. 

But we have been doing this in this community for over 30 years. 

We’re celebrating next year our 40th Anniversary for the Senior 

Resource Development Agency. We have over 12 different types of 

services. Most all of them are reflective of meeting our mission 

which is keeping seniors living in their homes as long as possible 

and being independent and being productive and having a great 

quality of life. 

We are the focal point for senior services within Pueblo County. 

We not only serve Pueblo County but we also serve 11 other rural 

counties. We also are the 2–1–1 for Southeastern Colorado and we 

also are the provider of Lifeline which is the emergency response 

systems from the Kansas border to New Mexico to the Four Corners area up to Colorado Springs. We even have an office in Colorado Springs. We have almost 2,500 subscribers. 

It’s a for-profit component of our agency and I think one of the 

things that’s unique about our agency is that we have nonprofit/forprofit together and we take that money and we pump it back into 

our agency to help the programs that need to be subsidized on a 

regular basis and I think that’s a key component about being able 

to provide a focal point. 

It takes a blending of funding and just to be able to provide nutrition services, transportation, in home services, under the Older 

Americans Act. We just don’t get the money and we provide it. We 

have to have support coming from the local area. The City and the 

County of Pueblo historically for over 30 years has been providing 

funding for the senior support system in our community somewhere to the tune of about $270,000 some a year is what they been 

providing recently to help us match and bring on other types of 

services for seniors in our community. 

So we’re very proud that we have that kind of local community 

support and I think it’s paramount in order for us to be able to provide the array of services that we do. 

Also within our community, it’s again a very diverse community. 

Probably somewhere 2,000, 1910 Census, we’re probably going to 

see that the Hispanic population is getting closer to 50 percent of 

our population within our county. Already within our public school 

system it’s over 50 percent and that’s reflected in the senior population. So there are those types of ethnic considerations that we 

have to take into—Pueblo used to be called the Little Chicago, Little Pittsburgh because of the steel mill and the diversity of Europeans that came to this community and which we are very proud 

of that heritage, plus of the Hispanic heritage that have contributed to our culture. 

All those things have to be taken into consideration in terms of 

providing services to the seniors in our community. 

The idea that we are talking about a blend of rural and urban, 

we are the only ones that provide transportation outside of the city 

of Pueblo. There is no other public transportation. A lot of seniors, 

as you’re well aware, are aging in place today, so that they’re living 

out in the mountain areas. They’re not moving into town. They’re 

25 

aging in place there and once they lose their ability to drive, as we 

all know, in this part of the country, when you can’t drive your car 

that directly has an adverse impact on your independence. 

So we feel very fortunate that we’re able to provide rural transportation. We can’t only do that with Title III money. We also have 

a blend of Colorado Department of Transportation money. By 

blending that funding with local funding from the city and county, 

we’re able to serve our urban area, plus our rural area, and keep 

it as cost-effective as possible. 

If one of those programs had to stand alone, there’s no way. You 

can only imagine what it costs to drive 40 miles one way to pick 

up somebody, take them back in four trips, how expensive that 

would be if you’re not having several different blended funding 

sources to help subsidize that and taking different types of passengers at the same time. So that’s an example for rural transportation. It really does need to be, I think, a blend of funding and 

a blend of who you’re transporting. 

The Meals on Wheels Program, we are so proud of that. For over 

30 years we’ve been serving, much like San Diego, 7 days a week, 

two meals a day, a hot and cold meal, delivered by volunteers, primarily it’s confined to the urban area. The rural areas we provide 

frozen meals. We would like to be able to do prepared meals from 

our kitchen but just haven’t been able to figure out how to keep 

the temperature requirements because, as you’re well aware, within our Older Americans Act program we watch out for those seniors. Nobody is more protected than seniors when it comes to nutrition and I think that’s a good thing, but we are very proud of that 

and some days we serve probably close to a thousand meals a day 

within our community. 

On the weekends, we had to cut back. So now we only provide 

meals to those individuals that are in the most need. Our programs 

have never been there to supplant the care that are given by family 

members and so when they have the ability to have family members take care of them, that’s what we would like to see happen, 

but for those that need it, there is no senior that should go hungry 

within our county and we’re very proud of that. 

In 30 years, we have never missed a day, not even in the big 

storm of 1997, we didn’t skip a beat. We were able to deliver our 

meals, thanks to our volunteers. 

I think this gives you kind of a snapshot of not only the diversity 

of services, transportation. We have information referral. We have 

the new ARCH Program in Colorado which, Senator, I better read 

it off. It’s Adult Resources for Care and Health. We blend that together. It’s case management and information referral. 

What I like about that program, and plus we combine it with 

2–1–1, is that it’s a gateway for baby-boomers to find out how to 

access the aging network for their aging family members and so 

really this is the first opportunity for all of us that are in denial 

that we’re ever going to get old which I think is a real characteristic of baby-boomers, that this is a chance. 

I mean, it’s not unusual for me to be out in a restaurant within 

our community and somebody comes up to me and says, Steve, my 

mom just had a heart attack, what do I do, where do I go, and this 

26 

is a person that’s 60 years old and doesn’t have any idea about the 

resources. 

So I think these programs, like ARCH and the 2–1–1, as far as 

pure information referral, those are a must in terms of being able 

to have baby-boomers become more familiar with the aging network. 

We have an array of other services. We also provide housing, 202 

Housing Project that we have within our community. So again, I 

was so happy to hear the Assistant Secretary talk about this in 

terms of being a great delivery system to reach out to seniors and 

also look forward to hearing from my colleague from San Diego. 

Thank you. 

[The prepared statement of Mr. Nawrocki follows:] 

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Senator UDALL. Steve, thank you, and I would note that the Assistant Secretary was generous. She never did mention the D word, 

Denial, but I was ready for it to be mentioned at some point here 

during the discussion. 

We’ll turn to Paul and welcome again. Thank you for making the 

journey from Southern California. 

STATEMENT OF PAUL DOWNEY, PRESIDENT, CALIFORNIA 

NUTRITION COALITION, STEERING COMMITTEE MEMBER, 

CALIFORNIA ELDER ECONOMIC STANDARD INITIATIVE 

Mr. DOWNEY. Great. Well, thank you very much, Senator. I guess 

I would note, if you were in San Diego visiting the fair, you would 

change into shorts and flip-flops. So we’re a bit different than here 

in Colorado. 

But it is, Senator, my pleasure to testify today at this important 

hearing and I commend your interest in wanting to improve the 

Older Americans Act, particularly the Nutrition Program. 

It’s also a pleasure to be here again with our outstanding Assistant Secretary for Aging Kathy Greenlee. I have a lot of admiration 

for what she’s done already in this position. 

As you noted, I come wearing two hats today. I’m president of 

the National Association of Nutrition and Aging Services Programs, 

otherwise known as NANASP. I’m also president and CEO of Senior Community Centers of San Diego. I have 15 years in the Older 

Americans Act Aging Network. 

I know you have a particular interest in programs and activities 

which promote wellness and foster disease prevention among older 

Americans and as the Secretary alluded to that’s precisely what 

we’re doing in San Diego. 

Senior Community Centers serves about 1,700 meals a day, 365 

days a year, to predominantly low-income seniors, many of whom 

live on less than $200 a month after paying their rent. 

The link between nutritious meals, health, independence, and, 

frankly, the ability to simply survive is undeniable. This year in 

the unique partnership with visionary philanthropists, private and 

public partnerships, and collaborations with more than 25 different 

community agencies, we opened the Gary and Mary West Senior 

Wellness Center. 

We firmly believe that it represents a model that can be replicated throughout the rest of the country in both rural and in 

urban settings. Our congregate meal numbers at the Gary and 

Mary West Senior Wellness Centers have increased every month 

since we opened in April to almost 700 a day. Nutrition is the core 

service around which we provide case management, lifelong learning and civic engagement. 

We then leverage our community partnerships to provide an 

array of additional services at no cost to us and to the clients. Our 

partners include Sharp Healthcare, which is the largest healthcare 

provider in San Diego County, and the College of Health and 

Human Services at San Diego State University. 

We have about 30 SDS use students representing five different 

disciplines, social work, gerontology, nursing, public health, and 

speech and language, and their professors who are out-stationed at 

the wellness center. Our seniors receive more services, students 

30 

learn about working with the elderly and the professors have research opportunities. 

This is what the Older American Act dollars were intended to do, 

to leverage other resources beyond merely providing a meal at locations where seniors gather each day. 

The next reauthorization must strengthen that ability at the 

local level to do this kind of leveraging. This can be accomplished 

by letting those in the aging network closest to the senior determine what is best in each of our communities, and let me be more 

specific. 

The Nutrition Program must continue its requirement that meals 

need to meet the recommended daily allowance, RDA, especially 

since 73 percent of the participants are at high nutritional risk. 

Sixty-two percent of our home-bound seniors receive half or more 

of their daily food intake from the meal. 

However, how this is achieved needs more flexibility. We anticipate a doubling of our minority elderly population in less than 20 

years. To keep nutrition programs relevant to them, we must offer 

food choices that reflect greater cultural sensitivity. We have 

boomers in our programs and more will follow. They need different 

menu options and approaches to serving meals to keep the programs relevant. 

One modification that we could make to benefit all the participants is to allow greater use of fresh foods and vegetables. We have 

too many obstacles and too many places now keeping that from 

happening. 

As you can imagine, the interpretation of what can be accepted 

via donation varies significantly from state to state and even from 

county to county. I encountered this firsthand recently when I tried 

to accept a reoccurring donation of fresh fish from a sports fishing 

consortium. State and local regulations, which the Older Americans 

Act says that we have to comply with, created such onerous impediments that we had to decline the fish which was worth several 

thousand dollars for each donation and they were going to do it 

every single month. So a sizable amount of money that we basically 

had to decline. 

We must have a system where laws at all levels of government 

work together consistently and fairly to encourage donations of 

fresh food and vegetables. 

My NANASP views parallel my local views. We support greater 

flexibility at the local level on whether more funds are provided to 

congregate or to home-delivered meals. 

For nutrition programs to deliver the outcomes they do, they 

must be adequately funded but that does not always mean more 

money. In this case, it is about making sure that dollars intended 

for nutrition stay in nutrition. Today, nearly $40 million in funds 

from the congregate nutrition program go into non-nutrition programs within the Older Americans Act. 

There may have been a need for that before but we don’t believe 

there still is when we have a rising demand in our programs. 

Those of us at NANASP truly appreciate your support of the 2009 

Stimulus Bill which provided an urgently needed $100 million in 

funds for nutrition programs. 

31 

Our programs faced rising food and energy costs and loss of volunteers. These funds helped avert disaster. 

But the need remains and we need to see funding levels for fiscal 

year 2011 as close to this level as possible. 

NANASP also supports strengthening the Disease Prevention 

and Health Promotion Program in the Older Americans Act going 

forward, and we’re calling on Congress to either transfer this program outright into the Nutrition Program or set aside funding for 

evidence-based nutrition programs which will help in prevention 

and promotion. 

Finally, in the special recognition to our rural seniors, funding 

for transportation services has to be—we have to bolster funding 

because they are essential to nutrition programs and all of the 

wrap-around services. 

NANASP has enjoyed working with the Administration on Aging 

in the early stages of the reauthorization process, working with 

Assistant Secretary, and looks forward to working especially with 

you, Senator Udall, and your colleagues on the Special Committee 

on Aging to achieve a successful, innovative, and forward-looking 

Older Americans Act. 

Thank you. 

[The prepared statement of Mr. Downey follows:] 

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Senator UDALL. Thank you, Paul, and I’ll turn now to Guy 

Dutra. 

For Paul’s benefit, I’m sure everybody else in the audience would 

understand this reference I’m going to make, that we have a member of the Colorado Springs community and Pueblo is always a nice 

event and there tends to be a bit of a sibling rivalry between Pueblo and Colorado Springs, but any time we can join these two communities, wonderful communities, it’s important to bring them together in this way. It’s always helpful. 

So welcome to Pueblo County and we look forward to your testimony. 

STATEMENT OF GUY DUTRA-SILVEIRA, DIRECTOR, PIKES 

AREA COUNCIL OF GOVERNMENTS AREA AGENCY ON AGING 

Mr. DUTRA-SILVEIRA. Well, thank you. As a person who has a sister who lives here, I get down here a bit and enjoy that sibling relationship. [Laughter.] 

So thank you for the opportunity to testify today. I’m here not 

only representing my own agency, the Pikes Peak Area Council of 

Governments Area Agency on Aging but also to some extent 

CAAAA which is the Colorado Association of Area Agencies on 

Aging. 

I want to thank my colleagues for their faith in me in giving me 

this role. 

I want to start by venturing an opinion. The 1965 Older Americans Act was a brilliant piece of legislation. It created simple support systems, such as Nutrition Programs, Transportation Services, 

In-Home Care, and Information and Assistance, that reduced the 

use of more expensive supports, such as Medicare and Medicaid. 

It’s crucial that these concepts be brought forward as we reauthorize the Older Americans Act so that we can enhance the quality of the lives of Older Americans at the same time while controlling public costs. 

Every area agency on aging, or I will to refer to them AAAs, 

every one is unique and the region they serve is unique. With local 

control, AAAs are able to tailor-made their services to the communities in which they serve. In my area, we have two very rural 

counties and one that has the city of Colorado Springs in it. So it’s 

very, very different. 

My urban area, congregate meals are a very good option, but in 

Park and Teller Counties, the home-delivered meal is absolutely a 

must. Fortunately, we have funding for both of these options 

through C1, C2, Titles C1 and C2, and we have some ability to 

transfer funds between these two funding sources. We get to do 

this once a year when we do our funding requests and as flexible 

as this is, it’s not flexible enough. 

Let me tell you a brief story. Every year, we have the pleasure 

of the State Agency on Aging coming down and assessing our agency. Todd’s smiling. That’s a good thing. Generally, these assessments go pretty well but I want to tell you about one occasion on 

which we were found out of compliance and I’m going to ask you 

to avert your ears, Secretary. 

Ms. GREENLEE. Are you going to swear, Todd? [Laughter.] 

36 

Mr. DUTRA-SILVEIRA. But what had happened is we had used 

congregate meal funds for a home-delivered meal. How did this 

happen? Well, we have some of our congregate meal sites in lowincome housing units. This helps us target those in the greatest 

need in our community and one day one of the volunteer site managers had noticed that one of the regular diners was not there. So 

she inquired and found out that this person was ill. 

Well, she had a brilliant idea. She filled a tray, covered it and 

took it upstairs to the person that usually dines there. Magically, 

this congregate meal had now become a home-delivered meal and 

we were paying for it via the wrong funding source. 

So the state unit kindly pointed this out to us and told us that 

we could pay for it using C2 funds instead of C1. Well, to do that 

would have cost hundreds of dollars in new contracts, different regulations, different reporting. The volunteer meal site coordinator 

didn’t know about different costs of money, didn’t know about different regulations. She didn’t know about in-service. 

So the way I think of this is reporting regulations, different pots 

of money, hundreds of dollars, a meal or two to an ailing elderly, 

priceless. 

The moral of the story here is self-evident. Putting funds in silos 

often results in less-effective, less-efficient service. This is why the 

Colorado Association of Area Agencies on Aging recommends that 

local transfer of authority within the Older Americans Act, Title 

III, Subtitles, be enhanced. Flexibility is one of our top priorities. 

CAAAA also recommends that the reauthorization of the Act include language and funding authorization for aging disability and 

resource centers, also known as ADRCs. The challenges that clients 

in Colorado Springs face, for instance, are quite large because the 

service delivery is spread out amongst many, many agencies. 

Fortunately, we had the opportunity to begin a new ADRC and 

using the ADRC, we have been able to closely follow every referral 

we make to disabled persons and elderly persons in our community. We’ve been able to have some case management services actually go to the person’s home and bring that support and knowledge 

of the system to the client in a very convenient and very real way. 

Also, data-sharing has begun between agencies. So a person can 

enter the system at one place and have their information shared 

with another and their history can be looked at between agencies. 

It’s not a complete project by any means but it’s underway. 

There’s also a new ADRC here in Pueblo, as Steve mentioned. 

It’s called the ARCH Project. In Colorado, we always have to rename everything. So the Adult Resources for Care and Health is 

Colorado’s version of the ADRC, and once again area agencies on 

aging stand ready to serve and tailor-make their ADRC or their 

Title III program or whatever it is to their community and make 

it work. 

As we begin to look at the challenges and opportunities in the 

Affordable Care Act, AAAs stand ready to serve. In Colorado, we’re 

already engaged in presenting evidence-based programs to many of 

our communities. Last year, Colorado AAAs gave over 4,000 individuals evidence-based programs. These programs were designed to 

help people stay healthy so they don’t have to utilize medical and 

institutional services and they saved a lot of money by doing that. 

37 

Clearly, our AAAs are involved in healthcare in America. My recommendation is that funding for these programs that currently 

must compete with our other programs be dedicated and that it 

come from the Affordable Care Act. 

One concern I have as a AAA director has to do with serving all 

of our elders. One of the recent opportunities that has come down 

is something called the Veteran-Directed Home- and CommunityBased Service Program. This is a program that will provide case 

management to veterans and allow them to make choices that 

would help them stay in their homes, stay independent, and not 

rely on expensive institutional care. 

In my area, I have almost 80,000 veterans, yet I’m ineligible for 

this program because we don’t have a veterans’ hospital. Now this 

concerns me not only because I want to serve our veterans but also 

because my experience tells me that often one opportunity builds 

upon another. Those areas that have been able to institute ADRCs, 

for example, have had more access to funding for such things as 

the Medicare Improvement for Patients and Providers Act, also 

known as MIPPA. 

I would ask that when we’re starting new incentives, that we 

keep in mind those areas that already have less resources. They do 

not have less need. Many of these areas are rural. Please keep in 

mind they need service, too. 

As we look at the reauthorization of the Older Americans Act 

and we encourage healthy living for baby-boomers and beyond, 

AAAs and Title VI programs must be vital partners. Their efforts, 

again tailor-made to their communities and free from the influence 

of special interests, will be part of the fabric that brings primary 

healthcare to all Americans while controlling costs and improving 

the quality of their lives. 

Thank you. 

[The prepared statement of Mr. Dutra-Silveira follows:] 

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Senator UDALL. Thanks, Guy, for that, and I’m generating a nice 

list of questions. I’m sure the audience is, as well. We’ll now turn 

to Dace for her testimony. 

STATEMENT OF DACE CARVER KRAMER, AGING WELL 

Ms. KRAMER. We’ve heard a lot this morning about baby-boomers 

and I plead guilty, also. I actually 2 weeks ago retired from the 

Northwestern Colorado Visiting Nurse Association, but I’m reminded of baby-boomers as a college student. We all had a rather 

immodest view of our ability to create change and as I became passionate about one cause or another in college, I was not very good 

at my college studies. I didn’t actually fail but my grades did go 

down and as you can see from my presence here today, I’m failing 

at retirement, too. 

I’m passionate about aging and about rural areas and I do not 

intend to step away from my representation of an organization of 

which I am extremely proud. The Northwest Colorado VNA is the 

public health agency for a two-county region in the northwest corner of the state. Geographically, Routt and Moffat Counties comprise an area about the size of the state of Connecticut. We have 

only 50,000 people in our two-county region. So when people talk 

about Pueblo as a rural area, I am kind of amused and bemused 

by that. 

We function as a public health agency but we do—and you’ll 

have to forgive me as only 2 weeks apart from this, I cannot separate the present tense and the first person from my remarks about 

the VNA and the aging program. 

So I will talk about the VNA first as the public health agency 

which has delivered an integrated system of health disease prevention and health promotion for many years to all citizens of our region, regardless of their ability to pay. 

We start with pregnant mothers and we provide services to 

women and children, to school health programs, to immunization 

programs, all the way up through and including end-of-life care 

with Northwest Colorado Hospice. So it’s a very visionary, very 

dedicated group of people. 

In the last 5 years or so, Sue Birch, who’s in our audience, our 

CEO, has dedicated herself to filling many serious gaps in the frontier area of our region with infrastructure for health promotion. 

Some of the things that have happened in the last 5 years are that 

the VNA operates a federally qualified health center for people who 

are uninsured and underinsured. So we provide primary care services and ancillary services to those people. 

We acquired an assisted living center which houses about 19 people. It is the only one in the region. We recently renovated a house 

in Steamboat Springs area for respite and end-of-life care which is 

an absolute shining star in the Steamboat Springs area. We not 

only provide end-of-life care, respite care for caregivers, we have 

adult day services. We have a support program for children in this 

facility. So there a great many infrastructure improvements which 

have never—we’ve never had in our region and I credit the VNA 

for that. 

Recently, I retired as the director of the Aging Well Program 

which is really one of the programmatic underpinnings of these faVerDate Nov 24 2008 15:07 Feb 01, 2011 Jkt 000000 PO 00000 Frm 00045 Fmt 6633 Sfmt 6633 H:\DOCS\63678.TXT SAG PsN: JOYCE
42 

cilities and services that the VNA provides. It was started in 2005. 

It has focused on the wellness and prevention services and programs that we, with the public health mission of the VNA, can 

offer to our seniors. 

We do this by adopting and hiring certified instructors in evidence-based fitness activities. We have Arthritis Foundation exercise, aquatics, and Tai-Chi, fall prevention programs, such as balance, and we have engaged over the entire Western Slope in helping to recruit and implement the chronic disease self-management 

program which in Colorado has been renamed Healthier Living 

Colorado. 

In our area, we provide that program in English and in Spanish 

and we also provide it for people with diabetes. 

So it’s the Healthier Living Diabetes Program in both English 

and Spanish. 

One of the ways we leverage the effect of these programs through 

the VNA is we receive referrals from our primary care providers at 

the federally qualified health center. We identify people in need 

through our community outreach and prevention services team, 

community health educators, patient navigators. We partner with 

our two local hospitals, so their discharge planners know that we 

have wellness and prevention programming available to people who 

are discharged and are transitioning back to their homes. 

This is a tremendous challenge in a frontier area. Most of our 

towns are not over 500 to 750 people. The way we manage to do 

it is that we partner with our community resources. Paul has 

talked about the leveraging of community resources. They include 

the hospitals. They include primary care providers. They include 

two community colleges to provide lifelong learning opportunities 

and then we identify social gathering places in our local communities which are the visible signs of gathering. They could be a coffee shop. It’s the American Legion Clubhouse in Craig, CO. 

We get partnerships with organizations that have facilities where 

people might logically come. We have no transportation, but we 

find that we have been so successful in integrating the services of 

the VNA, including wellness checkups, foot care, and the evidencebased programs that we provide with college classes. It might be 

memoir-writing. It might be something like computers. 

The County Extension Service offers classes and lunchtime lectures. We bundle all this together and place it in a social gathering 

place. It might be a community center, also, and we find that people find their way to our program. 

We have a population in the two-county region of over 60 that 

is about—I think it’s about 6,000 people and in the last 4 years, 

the Aging Well Program has seen 1,400 participants over the age 

of 60 in our programs. We collect data from all these people on 

their personal health and I would like to break in a little bit and 

read you—we did a survey of personal health assessment in 2009 

and we asked for comments about people’s perception of their own 

health, their ability to age in place, and I have a couple I’d like to 

read you that were part of our survey. 

‘‘I’m no longer on oxygen. I have lost 10 pounds and I’m stronger. 

I’m stronger and in better health all around. I feel more invigorated and I breathe better. My blood pressure has improved. I can 

43 

do my own yard work and housework now. My balance has improved and the numbness in my hands is less severe. I feel I can 

do more physical things in life. I feel more positive about aging.’’ 

These are actual quotes from people who’ve participated in Aging 

Well Programs. 

We also partner with—I feel like the kid standing outside the 

chain link fence because I have read all of the Older Americans Act 

and I can insert a little personal comment here. I was born in the 

state of Idaho and my—we moved to Washington, DC., when I was 

5 years old. My father was asked to come to Washington as newly 

elected Senator Frank Church’s first chief of staff. So I grew up in 

Washington but for those of you who have a little history in your 

background, you may know that Senator Frank Church was one of 

the founding members of the Senate Special Committee on Aging. 

He really pushed for the Older Americans Act that President Johnson signed into law because, in Idaho, many of the problems of the 

very rural and frontier areas, many of his constituents faced and 

he was passionate about aging and how to address those issues for 

his constituency. 

So I have a personal connection to this and it’s a longstanding 

one. I have great admiration for all of the members that sit on this 

committee and I appreciate the opportunity to be here. 

Senator UDALL. Dace, nicely done, and that was an important 

historical perspective. I didn’t know that particular part of Senator 

Church’s very distinguished service to our country. He was quite 

an American. 

Ms. KRAMER. Yes, he was. Thank you. 

[The prepared statement of Ms. Kramer follows:] 

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Senator UDALL. Thank you. That is, I know Secretary Greenlee 

notes with interest, too, that part of the idea was driven by a man 

who represented a very rural state, the state of Idaho, and he saw 

the challenges, frankly, that people had as they aged in place and 

whether they were frontier or rural or even the few cities or the 

one city that’s in Idaho. I guess Boise would be your city. 

Well, with that, thank you for that broad-based testimony and 

for giving us some specific recommendations. I know that the Secretary was taking some notes and particularly, Guy, you made 

some specific recommendations. 

Let me ask a couple questions and then those of you in the audience, I’ll try and limit my questions to 5 minutes and then if some 

of you want to ask questions, I really want to provide that opportunity. 

Steve, I want to pick up on something you talked about which 

was the fact that boomers have been eligible for OAA services now 

for about 4 years and, as we all know, many, many more of us will 

be eligible in the next 5 years, and we have this dual population 

dynamic at work and you alluded to this, where somebody at the 

young age of 60 who is concerned about their mother, I think it 

was, and yet that particular individual also is now in this cohort 

of seniors. 

Maybe start with you and your comments on what you’re seeing, 

what you’re learning from this dual population. 

Mr. NAWROCKI. Well, Senator, I was really excited when I turned 

60 because I was eligible for our programs. I could actually eat at 

a congregate meal site for a suggested donation and I am now turning 65. So I’m at the other end of the baby-boomers. 

But we have within our community, not unlike any other community, again we have such a large population of baby-boomers that 

are seeing their parents age, for those that are lucky enough to still 

be alive. 

When I first got into the aging services about 20 some years ago, 

the fastest-growing segment of the population was 85+. Now it’s 

over 90. I mean that’s incredible. What does that tell you? 

So when we look at the reauthorization of the Older Americans 

Act, 60 is the entrance into those services and people are living 

into their 90’s, driving their cars, I mean in our area, we have people that are driving in their 90’s, still getting drivers licenses. We 

have to start looking a little bit differently in terms of that’s a lifetime in terms of possibility of services, the kind of resources that 

will be available, especially for baby-boomers when there could be 

70 million of us that could be within that age cohort. 

So again, I don’t look at myself, even though I’m eligible for that 

congregate meal, I don’t quite look at myself as the same. I feel 

quite young. I feel invigorated every day coming to work because, 

well, the people that are 80 and 90 that we’re serving that are 

walking and talking and so I don’t see that I’m in need of these 

services myself. Of course, my health could change. As long as you 

have your health you have everything and those people that I see 

every day, those are the ones that have their health, not the homebound that we’re serving. 

So that can happen at any age and that can also happen for people that are disabled that are under 60 that are not eligible for 

48 

Meals on Wheels unless they live in the senior high-rise and that’s 

another area that I think we ought to take into consideration in 

terms of being more flexible and being able to serve in the community. 

Those baby-boomers that are under 60 that are disabled, especially with all the past wars that we’ve had and the near future, 

we’re going to have a lot of seniors in the future that are going to 

be disabled and I think we ought to take that into consideration, 

too. 

Senator UDALL. Any other members of the panel want to comment on this dual cohort dynamic where we have parents of seniors 

who are part of the OAA needs? 

Mr. DUTRA-SILVEIRA. I’ve been the director of my agency for 

about 3 years. Prior to that, one of the things I did was enter data 

for our caregiver program and what I noticed was not only would 

you have a 60-year-old taking care of someone that’s 85 or 90 but 

it was also the 90-year-old woman taking care of her husband and 

the 85-year-old neighbor next door. So caregivers who are over 60 

are not limited to young ones, they’re not limited to taking care of 

one person. 

Ms. KRAMER. We’ve had a philosophy with Aging Well that we 

need to ensnare people at the age of 50 to get them aware of the 

services that they may need in the future. So we have partnered 

with community organizations, like the community colleges, like 

fitness studios, restaurants, to make them aware that there is, first 

of all, marketing potential for this age cohort, but also to position 

these people to be much more aware when they become in need of 

our services, that those services exist, and I don’t know how successful I can claim we are at that, but we do have the local newspaper which has devoted one page every week for the last 3 years 

free of charge to the VNA, to the Aging Well page, simply so we 

can put information that will be of use and interest to people of all 

ages in the senior spectrum and that’s been a community success, 

I think. 

Senator UDALL. That term is useful, all ages in the senior spectrum. That’s an important way to put it. 

Paul, let me move to you and open the floor for your comments 

on this topic, if you’d like, but also, given that you’ve come all the 

way from California, I know we want to pick your brain about how 

we could put the practices that you’ve pioneered into action in 

rural communities and other parts of the country and that’s an 

open-ended question, broad question, but we’d like to hear you expound a little bit more on that topic. 

Mr. DOWNEY. Sure. Thank you. Well, first of all, I think we have 

to be careful not to pigeonhole any people in the spectrum, I think, 

in the aging spectrum. 

A couple of years ago I sat with my senior staff, all of us are 

baby-boomers, and I said, OK, who here would go to a senior center. Not one of us raised our hand. None of us could envision ourselves going to the model that Secretary Greenlee described, the 

old model of congregate meal in a church basement with nothing 

else and that was—no, that wasn’t anything we would do. 

So we tried to develop some things, innovative things that would 

be attractive to baby-boomers and, lo and behold, we discovered 

49 

that not only did it attract baby-boomers but, you know, we have 

85-year-olds who come in every day to update their Facebook pages 

in our Cyber Cafe, in fact, their e-mails and participate in the 

classes and so we kind of discovered that even those of us in the 

field sometimes have misconceptions about what seniors want and 

that I think it can work in both ends. 

I think what we’re seeing is, and it was mentioned, the idea of 

leveraging services, is that we should do what we do best which, 

for most of us, is in the meal area, is providing meals, maybe providing some case management, but looking to partner in what we 

do primarily. Most of our partners, the 25 that we have, are not 

other senior organizations. They’re healthcare organizations. 

They’re legal organizations. They’re community colleges. They’re 

other groups that bring things that are beneficial and what we do 

is we give them free space, say I’ll give you a free office, free space, 

telephone, with only two provisions. 

One is you have to see anybody who walks in the facility, you 

have to see and serve, and, two, you have to be part of an interdisciplinary team that we’ve created, so that we make sure we have 

comprehensive services, and I think that model can work very well, 

even in a rural area, as well, with sort of a hub of services that 

go out to satellite, to smaller satellite sites, to reach some of the 

folks maybe in the rural and frontier areas, but by bundling services that are, you know, with good transportation, if you have it, 

where you leverage resources and then going out. 

We do that in San Diego. San Diego County, I know, is certainly 

bigger than Rhode Island and probably bigger than a couple other 

states, as well, and we use that exact model ourselves, where our 

wellness center is our hub, but we have 13 sites spread out and we 

take those services and a day or two in each site, we’ll take what 

we do in this hub out to the satellite and I think that can work 

really effectively because I think getting the folks out of their 

homes is critical because of the socialization piece. 

Yes, you can get services to them, but if it’s a caregiver providing 

services, they don’t benefit from all of the other things and if you 

bundle them where you can, it also helps with the transportation 

issue. If you have a doctor, you know, medical, mental health, 

classes, meals, etcetera, in one location, then you can reduce some 

of those trips you need to make. 

Senator UDALL. I just think basically we use the term all across 

the senior spectrum. In a sense, we’re saying all across the community spectrum. I’m reminded, I think there’s been an ad talking 

about the human race. It’s a play on words in athletics and people 

actually running, but in the end, you want to take advantage of 

community services that are available to anybody in need, regardless of age, whether 6 months or 95, and that’s an intriguing way 

to think about this. 

I have a lot of questions, but I really want to get some audience 

involvement. So if anybody in the audience wanted to stand up and 

direct a question to the panelists. If you direct a question to me, 

I’m going to ask Jake to answer it, but please ask a question and 

I know if we run out of time, I can submit some additional questions for the record. 

Sir, would you identify yourself? 

50 

Mr. AGUILERA. My name is Carl Aguilera, and I’m a pharmacist. 

I’ve got Sam’s Club here in town. One of the questions that I—my 

question is before I moved to Pueblo, I lived in La Hara and we 

had some real tough problems in terms of retention and recruiting 

of primary medical, both primary—of medical providers, both primary and secondary. It was always real tough to get doctors in and 

even PAs, FNPs, and keep them there. At any rate that’s my question. 

I really don’t know that I’ve heard that addressed per se. Anybody got any answers? 

Mr. NAWROCKI. That’s a loaded question. It so happens he’s the 

brother of one of my colleagues on the City Council. 

Well, first of all, within our community, rural/urban, that is a regional medical center. In other words, we serve all of Southern, as 

you’re well aware, Southern Colorado and Northern New Mexico. 

People come to Pueblo for healthcare. 

I mean, we have community health centers. I mean, it’s just because of the lifestyle and the investment that people have. I mean, 

this is a struggling issue all over the Nation in terms of finding 

people that are willing to go into the rural areas. I know there are 

incentives at medical schools for kids that come from the rural 

areas to go back into those areas and they help pay and defray 

their costs. There’s Rural Medical Service Corps. 

But most people come to our city, as you’re well aware of, and 

so it’s more satellite service and a lot of physicians here go out to 

the rural areas and have a schedule where they meet in those communities. 

Ms. KRAMER. Senator, may I refer this question to my former 

boss, Sue Burch, the CEO of the Visiting Nurse Association? 

Senator UDALL. Sure. 

Ms. KRAMER. She might have some thoughts about this. 

Senator UDALL. Sue, would you? If you do, great. If you’d join us 

at the microphone? If you’ve been caught off-guard, I understand. 

It happens to me occasionally. We can have you submit some 

thoughts for the record, as well. 

Sir, are you talking about both doctors and nurses, PAs, across 

the board? 

Mr. AGUILERA. Yes. I know that the junior colleges or community 

colleges of Otero, Trinidad, Lamar, they all have nursing programs, 

but, you know, sometimes they stick, sometimes they don’t. I think 

they do a real good job in training their nurses. 

Senator UDALL. Sue, if you’d like, please. 

Ms. BURCH. I would just respond to that question and suggest 

that there really are three solutions to this very significant problem. 

We are so fortunate in the northwest corner to have created such 

an integrated model that it is now attracting the professionals that 

we need. In fact, we will be stealing from Wyoming a geriatrician 

to the Steamboat Springs area who is coming because of her belief 

in the integration of what we’re talking about and I think it was 

Steve and Paul referred to not only do we have to break down the 

social and medical—actually, it was Kathy, but this physician said 

you are creating exactly what I yearn to work in and so we have 

seen the two recent physicians that have come to the region, to the 

51 

Moffett County, Craig area, come because of the flexibility that we 

are creating. 

The other thing I heard up here, I think it was from—I keep 

thinking it was from this side of the table but it might have been 

Kathy, as well. 

But the mandate really, and I would hope, I know it’s not a mandate yet, but I would hope that AOA really—OAA, I’m sorry, really 

helps us push on this issue of inter-disciplinary teaming. It’s a hospice model. We need to get it upstream way ahead of hospice and 

physicians and the professionals yearn to work together in a different way and it attracts them. It keeps them in. It keeps them 

very involved. 

Then, last, I think we also have to create it so that our senior 

health centers, senior wellness centers, and it sounds like it’s going 

on in San Diego, become hubs for training these students in geriatrics or in aging models and we are very fortunate to be attracting 

students from the University of Colorado as well as other locations, 

Regis and other schools, that are wanting to come and send their 

students, public health students, nursing students, physician students, because they love the social and medical mix and so those 

would be three very practical ways that we can infuse more of that 

and all of it is a relaxing of regulations and if I could just piggyback on the next question, I don’t know if that helps at all, but I 

want to know from panel members and I know we have some examples locally, but what bridges, Kathy, are being built at the Federal level, at the national level, at the state level, and certainly at 

the local level, what bridges between departments will help us 

break down these silos, and what is being done at the administrative level to really foster more of this flexibility and integration? 

Senator UDALL. Let’s have the panelists respond and then as we 

conclude, I know that Assistant Secretary’s also prepared to make 

some remarks and she may at that time want to respond, as well. 

So if any panelists would like to respond, please. 

Mr. DOWNEY. I cannot say how much I agree with the idea of the 

interdisciplinary team. That’s one of the things we’re teaching with 

our San Diego State model, but the interesting thing, I have a licensed clinical social worker who’s my chief operating officer and 

she’s in her 50’s and she was taught as part of an interdisciplinary 

team and we got away from that and so what we’re kind of doing 

is going and dusting off an old model that worked really, really 

well. 

But if we’re going to be successful and leverage resources, we 

have to do that. 

Senator UDALL. Others want to respond to Sue? 

Ms. KRAMER. I would just say, and this is really more directed 

at the Assistant Secretary Greenlee, the one thing I did not get a 

chance to say is that I’m not part of the Aging Network in the 

state, although many of my favorite people are in the network. 

We’re not a AAA. We are a public health agency. 

We do these things which meet the goals and objectives of particularly the 2006 amendments to the Older Americans Act, but we 

receive, other than a very small amount of funding which actually 

ran out in February because we exceed—our demand exceeded our 

52 

ability to cover it, we receive a very small amount of Title III funding for our senior wellness checks and our foot care program. 

But some of the more innovative things that the Aging Well Program does are funded entirely by grant funds and I would like to 

really see some—again, and you spoke to it, but some bridging of 

the original intent of this Act which was to be a partner with Medicare and CMS and to try to find programs that are not penalized 

if they’re an organic program that, like the San Diego program, like 

Aging Well, that aren’t penalized because we don’t have sustainable funding. 

Next year, this program might go away because OAA does not 

support us. So that’s my pitch for being a community collaboration 

that works and meets the objectives but is not in the traditional 

conduit for those funds. 

Senator UDALL. If I might, too, respond to the gentleman’s initial 

question, in the Affordable Care Act, there is a provision which was 

based on a piece of legislation I introduced called the Rural Physicians Pipeline Act and it was based, the legislation, on a model 

that’s been developed at CU whereby recruiters go into rural communities, convince young future doctors that it makes sense to attend medical school, shoulder the burden that it will cost you financially with an understanding that that burden will be lessened if 

you will return to that rural community in which to practice medicine. It’s been very successful. 

It needs resources and the idea was attractive enough to me and 

my team and ultimately to the U.S. Senate that we included it in 

the final version of the landmark healthcare reform efforts. 

Now we have to find the monies for it. We did get some initial 

appropriation from Senator Harkin’s subcommittee, right, Jake, 

and so it’s underway. This will take time obviously because training a doctor doesn’t happen overnight, but if you think about that 

part of the pipeline being enhanced and funded along with this interesting idea that you create a magnet effect in rural communities 

that begin to implement this interdisciplinary approach, then that’s 

certainly the beginning of meeting the challenge that you just outlined which we all know is a big one and one of the challenges— 

I know Kathy, Secretary Sebelius and all of us as we provide care 

to all Americans, we’re going to need additional providers. 

It’s an important acknowledgement to make but it’s a problem I’d 

rather have because what we’re doing in providing care for all 

Americans is the smart and the right and the moral thing to do. 

Who else would like to ask a question or make a comment? 

Mr. COFFEY. Kind of an observation more than a question. 

Senator UDALL. Yes, sir. 

Mr. COFFEY. My name’s Todd Coffey. I’m the manager of the 

State Unit on Aging. 

Senator UDALL. You were referenced earlier, right? 

Mr. Coffey. Yes, I was, sometimes in vain. My observation is I’m 

a member of the National Association of State Units on Aging 

which recently changed its name to the National Association of 

States United for Aging and Disabilities. 

The main reason why we made that name change was to acknowledge that interaction and overlap between the services that 

the Aging Network provides for older adults as well as the people 

53 

with disabilities and to the extent possible that the Act can acknowledge that interaction and build in supports so we can serve 

people that might be 55 years old that are disabled, not eligible for 

Medicaid, can’t access any other type of funding stream, and to customize programs that can meet both groups of people. I think that’s 

an important goal of what NASUA is trying to do, too. 

Senator UDALL. Thank you. Anybody care to comment on Todd’s 

comments? 

Mr. NAWROCKI. Senator? 

Senator UDALL. Yes? 

Mr. NAWROCKI. Again, I think I have kind of had alluded to that 

in terms of providing services to the disabled within our community. We’re able to do that through some of our programs, but it 

really is difficult when they don’t meet the criteria and that for all 

practical purposes, if they’re living in a high-rise senior apartment 

building, then they can get Meals on Wheels. 

But in terms of out in the community, there’s such great need 

for that. I only see that growing because of all the disabled vets. 

Senator UDALL. Again, I know we can continue at some length. 

I’m going to ask the Assistant Secretary to return to the dais, if 

that’s comfortable, and share some of her final thoughts and responses and then when she’s finished, I’ll wrap up with some very 

brief comments, including a thank you to Jerry and Pueblo, and 

we’ll move on to the rest of our day. 

Madam Secretary, the floor is yours again. 

Ms. GREENLEE. I’ll try and be succinct, but there are so many 

areas and so many topics. 

I wanted to back completely up and frame this really in the largest context that I know how. It is quite an honor to serve the country as Assistant Secretary. At this level, you have the opportunity 

to do something that you don’t have at the state level and that’s 

to represent the U.S. internationally. I have had that opportunity 

twice, to speak at a non-governmental organization event that 

AARP International did at the United Nations, and I also spoke at 

the International Federation on Aging Conference in Melbourne, 

Australia. At that point is the only time that I’ve been able to stop 

and really applaud the successes that we’ve had in this country. 

Passing Social Security for seniors in 1935 has been pivotal to 

dealing with poverty. Most of the people in the world who are aging 

don’t have that kind of comfort. Passing Medicare and Medicaid in 

1965 was enormous for providing support people as they age in 

terms of their health, as well as preventing poverty, if they’re dually eligible. Those successes are things we need to acknowledge 

that we have done and be very proud of. 

Those very successes also present, I think, a challenge for all of 

us in this room, whether we’re in the executive branch or the legislative branch. It can certainly lead to the question didn’t we cover 

everything when we added those three laws? It’s important that we 

all stop and champion together the fourth leg of this stool which 

is the Older Americans Act. Even with Social Security, Medicare 

and Medicaid, huge programs, there are still unmet needs that seniors have to help them sustain their lives in their communities and 

with their families. So regardless of how we go forward and my 

work in promoting the Act on behalf of the Administration and the 

54 

work of the Senate and Congress, the core need that all of us have 

is to stop and acknowledge that, yes, we need this. We didn’t cover 

the waterfront with those three laws, that this law is critical, and 

as Dace was saying, the Older Americans Act does not support you 

but AOA does. 

There’s a complete distinction between what we can do with the 

law, in the way it’s written, the way it’s funded, and the fact that 

this is a critical service that we’re providing. We all need to be 

champions, I think, for the fact that seniors need these services, 

however they’re written and however they’re funded, that they’re 

necessary, and that they are vital to our communities and to our 

livelihood. Moving forward, they will be even more important. So 

wherever we go from here, that’s the unifying message. 

The eligibility age of 60 came up and I just want to address it 

because it will come up in the reauthorization and always has. The 

age issue can walk you completely around in a circle. The purpose 

of the law is to target those in most need. As we look at the reauthorization, we must all go back to that section and look at the 

definitions of people who are the most needy. 

Although the law says that someone is eligible for services at 60, 

that is not the dynamic or the demographic of the people we tend 

to serve. Most of the people that we serve are the most frail, the 

oldest, and the most unhealthy Americans so that we have met the 

targeted goal of assisting people who are most needy. 

The age of 60 itself has been interesting to explain. I first had 

to explain it to Secretary Sebelius when she was Governor Sebelius 

when she turned 60 and, yes, I’m not saying 60’s old, but 60 is—— 

Senator UDALL. It wasn’t that long ago. 

Ms. GREENLEE. Yes. She’s 62 now. Age 60 is a starting point. 

People wonder whether it should be moved to 65 to coincide with 

Medicare. Social Security now for many people starts at 67. People 

wonder if it should start at 50. The number itself can be tricky. 

The underlying issue is the real goal that we must figure out is 

what are the best ways to articulate the targeting of those in need. 

The number itself is not the issue, it’s the targeting of the need. 

The other thing that’s very important to consider when we’re talking about a number is that health disparities do exist in this country. For people of color who have had difficulty accessing 

healthcare in the same way as have general population, certainly 

the white population has impacts these services, as well. 

Once we start changing the number, we have to be mindful of 

the impact on all populations, so that we don’t create disparities 

with the eligibility age itself. Then we can figure out how to best 

address the issues of disability. 

I think that can best be done with having our partners from the 

field of disability at the table and recognizing that we have disability advocates and systems that are our companions and they 

need to be here. 

In terms of the Affordable Care Act and the inter-disciplinary 

needs, they’re there. Congress passed that law. We’re working hard 

to implement it but issues remain with regard to rural providers, 

encouraging innovation, and building on partnerships between the 

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55 

tration, that funds the low-income clinics, as well as our partners 

at CMS. 

Everyone at HHS is pulling together to find these opportunities. 

It has been an exciting time to be literally at the table with the 

Department of Health and Human Services when we try to implement this phenomenal change in the laws given with the things 

that we can do now to assist all Americans, as well as for seniors 

which, of course, is my main focus at A.A. 

So thank you all very much for having me. 

Senator UDALL. Thank you, Secretary, and let me make a few 

final comments. 

First, I want to thank CSU Pueblo for hosting us. This is a wonderful resource and asset for Southern Colorado. President Garcia 

has been an outstanding leader, I know. I’m very proud to know 

him and honored to know him. If he’d have talked to me about getting into politics, though, I might have changed his mind, but, anyway, he’s, I know, well served by his team here. 

Jerry, thank you for your public service. Thanks for the nice introduction, leading us in the Pledge of Allegiance. I thank those 

who traveled a long way to be here with us. 

On behalf of the Chairman Herb Kohl of Wisconsin, I want everybody here to know that the testimony will be taken seriously. 

It will be studied. The questions that were answered will be utilized as we move to reauthorizing OAA and I will submit some additional questions for the record, as well, to the panelists. 

I really did want to hear from those who’ve taken the time to join 

us. I want to thank those in the audience who are part of this wonderful network that’s involved with our citizens, and I wanted to 

echo what, Secretary, you said about Social Security, Medicare, 

Medicaid, and I’ve certainly learned a lot about OAA today and add 

this perspective. 

One of the most important elements that sometimes isn’t acknowledged, particularly by critics of Social Security and Medicare 

and Medicaid, and hopefully to a lesser extent by critics of OAA, 

is that because of those landmark programs our generation has 

known that our parents will be treated with dignity, with respect 

and will not live their final years in poverty, and that’s enabled me 

and millions of other Americans to raise our families and pursue 

our careers with those assurances and with that security. 

That’s a wonderful gift that is a result of those leaders and those 

visionaries, both Democrats and Republicans, by the way, who supported these four key programs, and my final comment would be 

one that has, I think, both moral and practical components and 

that is, I think that we all agree as Americans there’s a value that 

every one of us has a contribution to make throughout our lives 

and we would also, I think, agree that you measure society by how 

it treats its least fortunate and most vulnerable populations, 

whether they be children, the disabled, or the elderly. 

Thank you, all. 

[Whereupon, at 1:05 p.m., the hearing was adjourned.] 

Æ